A day doesn’t go by that I don’t get questioned on what exactly happens to our libidos when we age and how to get it back on track.

Libido is a complex issue and while no 20 year old spends any time worrying about this natural gift, the more we age, the more concerned we become with its disappearance from our lives. Why is the husband still interested in having sex, when the wife, in her mid 40s and on feels she can spend the rest of her life celibate? What happened and what if anything can we do about it?

When it comes to the man, it’s simple. Men are fertile forever so their sex drive is innate and stays there for as long as their testosterone holds up (pun intended) and their life gives them the opportunity.

I am always concerned when people believe there is a miracle drug out there to fan the flames of desire.

Viagra may help the man get a better, harder erection, but if his testosterone levels are low, if his heart is not healthy, the act of sex may even increase his risk of heart attacks or stroke.

Women who have tried Viagra often say it works, as long as the desire is there. All the work must be done before you have sex.

What exactly is all the work anyway?

To better understand what happens, let me turn to puberty.

When our sex hormones get switched on by the master gland, the pituitary, we suddenly are flooded with estrogen, progesterone and of course testosterone. As the young girl, turns into a woman with her budding breasts, pubic and armpit hair and adult body odor, along with the start of her period, another unseen chemical, emotional change in her personality occurs. This change turns the asexual young child into a sexual woman.

Sexuality is essential to the perpetuation of our species. If people had no sex drive and the desire for sex (libido) did not exist, mankind would no longer exist.

So sex drive is a good thing especially when used in loving relationships that enhance peoples’ lives. But that is a cultural statement, let’s stick with the physiology.

Back to our hormones.

Sexual feelings peak during our most fertile years. Women are pretty much fertile until menopause. However, as they enter their late 30s-40s and the hormone balance changes and the production of estrogen, progesterone and testosterone diminishes and so does the sex drive. It is physiologic. When we ovulate we feel very sexy. We are full of desire not only because we love our mate (of course I hope we do), but because our hormone balance tells us now is the time we can get pregnant and thus we want to have sex.

Once ovulation is no longer a consistent part of our lives, we have already had our children and they are at least physically, if not economically or emotionally independent, we no longer need to be fertile thus no longer need our sexual desire to be at peak levels.

As the hormone balance shifts with age, estrogen, progesterone and testosterone become scarce, we no longer ovulate and the sex drive plummets.

Logically one would think that putting the runaway hormones back into the mix would immediately bring sex drive back. Not quite. In study after study, putting in estrogen, progesterone and testosterone or testosterone alone (which is often thought to be the main hormone responsible for our sex drive) is not enough.

This is why. Now, life has taken its toll. We are busy with work, raising kids, looking at his dirty clothes or just building resentment in our relationships over a few decades we have spent together. None of this is good for our sex drive.

In addition, by now in our 40s and 50s, we are probably taking some medication. A little antidepressant, some blood pressure medication, maybe something to decrease the cholesterol levels or just a drug to improve our bone density.

The result, an emotional and physical barrage of sex blockers.

Is it all lost? No, if we can hook each one of us to the internet and to a cell phone, the least we can do is put that sex drive back into our aging men and women.

With the kids out of the house, instead of dreading spending the rest of your life with the hunk you married and loved to pieces sexually, you should be happy to get the opportunity to do it all over again, And this time just for the two of you.

I help my patients by bringing back the estrogen, progesterone and testosterone in bioidentical formulations, making sure the thyroid is well balanced, adding some pregnenolone and DHEA to the mix. I also make sure to spend lots of time teaching my patients how to eliminate as much of the other medications they take as possible, safely, and increase their romantic time while rebuilding the passion with their spouse or significant other.

It may take a little more time and a lot more thinking to get there than it did at 20 but I promise you the sexual experience is well worth it. And you get a bonus. Women who are sexually active into their 50s, 60s and on are healthier and have fewer problems with depression or chronic illnesses. That alone should be a great incentive. The baby boomer generation is not going into their twilight years without taking sex with them all the way!